NUR 1211C-Part II: Perforated Bowel-Sepsis-ICU NextGen Unfolding Reasoning-Mary O’Reilly-2022-2023

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Mary O’Reilly, 55 years old Primary Concept Infection/Inflammation Interrelated Concepts (In order of emphasis) • Gas Exchange • Perfusion • Clinical judgment NCLEX Client Need Catego... ries Covered in Case Study NCSBN Clinical Judgment Model Covered in Case Study Safe and Effective Care Environment Step 1: Recognize Cues  • Management of Care  Step 2: Analyze Cues  • Safety and Infection Control Step 3: Prioritize Hypotheses  Health Promotion and Maintenance  Step 4: Generate Solutions  Psychosocial Integrity  Step 5: Take Action  Physiological Integrity Step 6: Evaluate Outcomes  • Basic Care and Comfort  • Pharmacological and Parenteral Therapies  • Reduction of Risk Potential  • Physiological Adaptation  Copyright © 2020 Keith Rischer, d/b/a KeithRN. All Rights reserved. Part I: Initial Nursing Assessment History of Present Illness: Mary O’Reilly is a 55-year-old female with a prior history of partial colectomy w/colostomy who was admitted to the medical/surgical unit for small bowel obstruction. Yesterday she developed severe RLQ abdominal pain and CT revealed a perforated small bowel with free intraperitoneal air. Before she was brought to the operating room (OR) for an exploratory laparotomy, her lactate was 4.9, WBC 18.9, and her systolic BP began to drop to 65-75, with a mean arterial pressure (MAP) of 50-55. She received a total of 2500 mL of 0.9% NS preop and piperacillin-tazobactam 4.5 g. IVPB. Her last BP before she went to the OR was 94/52 w/MAP 65. CONTINUED....... [Show More]

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